Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. e725-e732 (doi:10.1542/10.1542/peds.2005-0779)
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Comparison of Techniques to Evaluate Adiposity in Stunted and Nonstunted Children

Daniel J. Hoffman, PhDa, Ana L. Sawaya, PhDb, Paula A. Martins, PhDb, Megan A. McCrory, PhDc and Susan B. Roberts, PhDd

a Department of Nutritional Sciences, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
b Department of Endocrine Physiology, Federal University of São Paulo School of Medicine, São Paulo, Brazil
c School of Nutrition and Exercise Science, Bastyr University, Kenmore, Washington
d Energy Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts

OBJECTIVE. The use of anthropometric measures (eg, skinfold thicknesses, BMI) to assess obesity is not without controversy and has not been explored with respect to the use among groups of children with growth retardation (ie, stunting). Therefore, the objective of this study was to determine whether growth retardation affects the accuracy of field methods for assessing body composition in children.

METHODS. A cross-sectional study was conducted in 30 stunted children and 30 nonstunted children who were matched for age- and weight-for-height z score and living in the shantytowns of São Paulo, Brazil. Body composition (fat mass, fat-free mass, and percentage of body fat [%BF]) was measured by H218O dilution (reference technique) using group-specific values for the hydration of fat-free mass and dual-energy x-ray absorptiometry. BMI and body composition that were calculated from 3 pediatric skinfold prediction equations were evaluated for accuracy of %BF in comparison with the reference technique.

RESULTS. Stunted children were shorter and weighed less than nonstunted children, but BMI did not differ significantly between groups. All 3 skinfold equations tested resulted in a calculated %BF that was significantly lower than that measured by H218O dilution for both stunted and nonstunted groups, and %BF as calculated by any of the skinfold equations tested did not significantly predict %BF by H218O dilution. In contrast, BMI significantly predicted %BF in both stunted and nonstunted children, and this relationship did not differ by growth status.

CONCLUSION. BMI but not skinfolds significantly predicted %BF measured by H218O dilution. The relationship between BMI and %BF did not differ between stunted and nonstunted children; this indicates that BMI can be used in field studies of obesity and stunting. However, the prediction of %BF by BMI is relatively poor in both groups of children, and continued investigation of more accurate field methods for measuring %BF is warranted.

Key Words: body composition • BMI • stunting • obesity • developing countries

Abbreviations: WHZ—weight-for-age z score • HAZ—height-for-age z score • DXA—dual-energy x-ray absorptiometry • TBW—total body water • FFM—fat-free mass • %BF—percentage of body fat • FM—fat-mass

Accepted Oct 17, 2005.


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C Corvalan, C. Gregory, M Ramirez-Zea, R Martorell, and A. Stein
Size at birth, infant, early and later childhood growth and adult body composition: a prospective study in a stunted population
Int. J. Epidemiol., June 1, 2007; 36(3): 550 - 557.
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